A and E (Major Incidents)

Chris Skidmore Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am aware of the situation in Leicester. The hospital has had significant space pressures in its emergency department, and a couple of nights ago it had a high in-flow during one night, but it is absolutely on the case in trying to resolve this. What are we doing? We have put in £9.2 million of winter pressures money to make sure that whatever people decide the right solution is, it is not through lack of resources that they cannot do it.

[Chris Skidmore (Kingswood) (Con)]

Last Saturday night, while I was visiting my wife’s family in Leicestershire, my baby daughter suddenly became quite ill. Rather than going to A and E, we rang the 111 service and were quickly referred to Loughborough urgent care centre, where we had fantastic treatment; I pay tribute to the staff. Does this not go to show that we need to prioritise new models of urgent care, as set out in Simon Stevens’s review?

[Mr Hunt]

We absolutely do that. Telephones and the internet provide different ways to get the right advice to people quickly. The 111 service is taking a considerable amount of strain at the moment, and we have put in more money to support it. We are investing a lot more in tele-health and tele-medicine, and a lot more to help GPs who want to give people out-of-hours appointments. In the long run, that is the way we will reduce the kinds of pressures that my hon. Friend talks about.

Tobacco Products (Standardised Packaging)

Chris Skidmore Excerpts

Thursday 3rd April 2014 Commons Chamber

[Jane Ellison]

The Government have a tobacco strategy that has been published. Today, I am presenting a statement about standardised tobacco packaging and nothing else.

[Chris Skidmore (Kingswood) (Con)]

In my constituency the printer Amcor prints more than 5 billion cigarette packets a year and is one of the largest manufacturing companies of its kind in the country. The factory employs 150 local people and there is a manufacturing train of more than 1,000 local people. I support any measures that will reduce smoking among impressionable young people, but when the Minister talks of standardised packaging, is there any chance that after the review is conducted she can talk of “standardised and complex” packaging, to secure those local jobs at Amcor and other printing companies across the country?

[Jane Ellison]

My hon. Friend is right to draw attention to the fact that standardised packaging is complex and far from the plain brown paper packs sometimes portrayed. Sir Cyril mentions that issue and draws a clear distinction in his report. I would welcome my hon. Friend making a submission to the consultation about the impact of this measure on employment in his constituency. That will of course be weighed in the balance, but it is important constantly to remind the House of the enormous economic impact of the burden of disease on our population.

Health Care (Gloucestershire)

Chris Skidmore Excerpts

Wednesday 19th March 2014 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

My hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I have been calling for this debate for some time, so we are grateful for the opportunity to discuss health care provision in south Gloucestershire.

In 70 days’ time, the accident and emergency department at Frenchay hospital in south Gloucestershire will close its doors. The decision on this is not recent, as it was taken in 2005 under the Labour Government, who then refused to allow it to be referred to the independent reconfiguration panel, despite a 50,000-signature petition from local people. The decision to close the A and E was also voted through locally by Labour councillors against Conservative opposition. When my hon. Friend and I were elected to this place in 2010, we called a debate on the future of Frenchay hospital in which it was confirmed that contracts had already been signed under the Labour Government to close Frenchay’s A and E, making the decision irreversible. The downgrading of Frenchay will forever be Labour’s legacy to the people of south Gloucestershire. My hon. Friend will speak later about the hospital and the continuing uncertainty over the health care provision that will be based there.

For the first time, this Government allowed South Gloucestershire council’s health scrutiny panel to refer recent decisions by health care managers temporarily to relocate beds to Southmead hospital while the final provision of beds at Frenchay was investigated by the independent reconfiguration panel—something that the previous Government resolutely refused to do. As local MPs, we submitted our own statements in support of Frenchay to the IRP along with local campaigners, and they are listed in the report’s appendix, yet we were surprised to see that no statements of support were made by the local Labour party or by its candidates.

The publication of the IRP report on Frenchay this week highlights—

--- Later in debate ---

Motion made, and Question proposed, That this House do now adjourn.—(Mr Gyimah.)

[Chris Skidmore]

The publication of the IRP report on Frenchay this week highlights for the first time real concerns about the reconfiguration of health care provision in south Gloucestershire. These concerns are so damning that it is right that we as local MPs raise them now on the Floor of the House. The IRP rightly observed not only that health care provision had been subject to continual alteration since 2005, but that

“there is considerable public disquiet with the process to date”,

that

“residents of the area should feel exasperated by the years of delay”,

that

“the overall process to date has shown a marked lack of empathy for patients and the public who have a right to expect better”,

and that

“progress to date has suffered from a lack of trust from the public”.

The IRP goes on to recommend that

“a new approach to pubic engagement and involvement is required that demonstrates mutual co-operation and ensures that the public can have confidence in a quality service”.

Importantly, the IRP also notes that

“concerns remain about access to outpatients and diagnostics, capacity for rehabilitation services particularly in light of housing developments, and the absence of external clinical assurance”.

The IRP has finally put on record what local people and groups such as the Save Frenchay Hospital group have long been saying. North Bristol NHS Trust and health care bosses must now listen to them, and to the IRP in the light of its damning conclusions.

I am concerned, however, that history is about to repeat itself at nearby Cossham hospital. As a member of the league of friends at Cossham hospital, and someone who volunteers at the café there—I hope that that will suffice as a declaration of interest—I know at first hand how cherished Cossham hospital is within the Kingswood community. In 2004, the hospital was threatened with closure. Then—a story all too familiar—the health care bosses said that they knew best and that there were strong clinical reasons for shutting the hospital, yet they underestimated the determination and resolve of the Save Cossham Hospital campaign group, which mounted a remarkable cross-party campaign to save the hospital from closure.

In the end, the decision to close Cossham was reversed, and the hospital underwent a £19 million refurbishment. So far, this has included a new renal dialysis unit, an X-ray and scanning department, physiotherapy and out-patient appointments, and Bristol's first free-standing, midwife-led birth centre, which has already delivered hundreds of babies. But the minor injuries unit at Cossham hospital, which was promised as part of the Bristol health services plan, and reaffirmed by the 2009 business plan for the hospital—signed and sealed, as it were—has not been delivered. Instead, the commissioning group is now considering installing a rapid assessment centre for the elderly in its place. Obviously we must consider an ageing population, but in this particular case we should be considering the needs of the entire health care community in south Gloucestershire.

As the local MP for Kingswood, I feel that not to have a minor injuries unit for Cossham is unacceptable. With Frenchay A & E closing in just 70 days, if local people are in need of treatment for an injury, they will have to travel 11 miles to Yate, or have to travel across Bristol to Southmead hospital or to the Bristol royal infirmary. As many local people know, public transport to Yate and Southmead is woeful, with the bus often taking several hours. Without a minor injuries unit at Cossham, I remain concerned about health care provision for the east side of the Bristol region. I set out the case for a minor injuries unit in my letter to the Health Secretary on 26 February, and I would welcome the opportunity for the reformed Save Cossham Hospital group to meet the Minister to present the case in detail. There is a clear and present need for a minor injuries unit at Cossham, and a clear and present danger to our local community if it is not delivered.

I cannot impress enough on the Minister that I believe that, just as in the case of Frenchay hospital, and in the light of the highly critical IRP report on its changing services, the ability of health care bosses continually to chop and change health care services at Cossham and in the south Gloucestershire area without regard to public opinion and confidence is extremely damaging. Above all, it raises questions about why local people, who pay for their health service through their own taxes, should feel, as the IRP report states, “exasperated” by the uncertainty surrounding the health care for which they have paid.

The people of Kingswood and south Gloucestershire, as the IRP has firmly stated, “deserve better”. We also deserve better when it comes to the provision of a minor injuries unit at Cossham. We were promised a minor injuries unit, we want a minor injuries unit, and for the sake of the health and safety of local people in my community, we need a minor injuries unit at Cossham hospital.

Oral Answers to Questions

Chris Skidmore Excerpts

Tuesday 22nd October 2013 Commons Chamber

[The Minister of State, Department of Health (Norman Lamb)]

I pay tribute absolutely to that local initiative, which is exactly the sort of direction we are going in. I have made the point several times that we cannot get great care on the back of exploiting workers. The idea that people should not be paid while they are travelling from one house to another is, in my view, unacceptable. When employers and care providers breach the minimum wage legislation, we should be absolutely clear that that is completely unacceptable. To ensure great care, the Government are introducing in 2015-16 the £3.8 billion integrated transformation fund, which will pool resources between the NHS and social care to ensure that we shift the focus to preventing ill-health and deterioration, and I think that that can make a real difference.

[Chris Skidmore (Kingswood) (Con)]

T7. I and my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) have long campaigned for the maximum hospital facilities at Frenchay hospital, including a community hospital with an outpatients clinic—as was agreed as part of the Bristol health services plan in both 2005 and 2010. Now it seems that NHS managers are attempting to revisit these plans, something to which I am opposed, as is my hon. Friend the Member for Filton and Bradley Stoke, who has recently written to the Secretary of State to ask for a meeting to look into the situation. Will the Secretary of State agree to meet us both and investigate the situation?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am always happy to meet colleagues for discussions, particularly when they are championing important health care facilities in their local area. I can confirm that the Secretary of State has received a formal referral from South Gloucestershire council in relation to these proposals, and has referred them to the Independent Reconfiguration Panel. He will of course consider the panel’s recommendations before making a final decision, and I am sure that my hon. Friend would agree that it would be inappropriate to pre-empt those deliberations.

NHS Commissioning Board

Chris Skidmore Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

When the hon. Lady talks about back-door privatisation of the NHS, I am not sure of her view of the previous Government’s commitment to spend £250 million on independent sector treatment centres, whether or not they undertook any operations. I am not sure that she agreed with it, but that is what her Government did. There will be no privatisation of the NHS, and the rules we introduce will make it absolutely clear that the power lies with clinical commissioning groups to use the tools available to them—co-operation and integration, but also competition where it drives up standards, just as her Government recommended.

[Chris Skidmore (Kingswood) (Con)]

Last year, the right hon. Member for Leigh (Andy Burnham) claimed that there were less than 72 hours to save the NHS. Yesterday, when referring on his Twitter feed to the regulations, he claimed that there were two weeks to save the NHS. Does not the Minister believe that in fewer than 140 characters, the right hon. Gentleman has shredded any credibility that he might once have had? [Interruption.]

[Norman Lamb]

I think my hon. Friend makes a valuable point. [Interruption.]

NHS Funding

Chris Skidmore Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

The priorities are all wrong. The Government are spending the money on a reorganisation that none of us wanted in the north-west, and as my hon. Friend says, cancer networks are being cut and are shedding staff. As my hon. Friend the Member for Leicester West revealed this week, they are cutting back on the vital work that they do—and there could be no more vital work. Yet we continue to have a false version of events given to us. Ministers must think we are daft, but we are telling the facts to the country today and people will judge for themselves.

When we put the whole picture together, what we see is a tissue of obfuscation and misrepresentation of the real position on NHS spending. The hon. Member for Mid Bedfordshire (Nadine Dorries), who is, sadly, not in the House today, once made some interesting observations about those on the Government Front Bench, but it is not just that they

“don’t know the price of pint of milk”.

The arrogance of which she spoke seems to give them a feeling that they can claim that black is white and expect everyone to believe it. If they say it is so, then it must be so. Well no, actually. The intelligence of the House need not be—

[Chris Skidmore (Kingswood) (Con)]

On a point of order, Mr Deputy Speaker. Has the right hon. Member for Leigh (Andy Burnham) informed the hon. Member for Mid Bedfordshire (Nadine Dorries) that he would be making comments about her in the debate today?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

That is not a point of order.

Regional Pay (NHS)

Chris Skidmore Excerpts

Wednesday 7th November 2012 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

It is a pleasure to follow my constituency neighbour, the hon. Member for Bristol East (Kerry McCarthy). I apologise for not attending the earlier Westminster Hall debate secured by the right hon. Member for Exeter (Mr Bradshaw); I will read the Hansard report to see what was said. I want to talk about the background to the debate and the south-west pay, terms and conditions consortium, which affects my constituency. We heard the right hon. Member for Leigh (Andy Burnham) and a few other Opposition Members talk of cartels. It is rather unfortunate that such language has been used, because we want trusts to work together to come up with productive solutions to the problems we face in the NHS.

I have heard from constituents, many of them nurses, who are concerned about what is happening. To be honest, I think that they are concerned because there is a lot of scaremongering and a lot of knowledge has not been put out in the open, partly because the unions that are driving the campaign are refusing to speak to the consortium and engage. We need that engagement from the unions, so I urge them to get around the table.

I wrote to the chief executive of the south-west pay, terms and conditions consortium, Chris Brown, to ask for his reasoning as to why the consortium was formed and why it has put the measures on the table—they are not definite and are there to be discussed by individual trusts. This is about flexibility for individual trusts. As has been discussed, the previous Labour Government provided that flexibility. It will be up to the trusts to decide. We should have faith in local foundation trusts to make the decisions that need to be made.

[Mr Robert Buckland (South Swindon) (Con)]

I am grateful to my hon. Friend for breaking down the language that has been used, because one of the worries my constituents have is that Swindon is right on the edge of the south-west region. The prospect of a wholesale regional pay structure causes them real concern. Is not the issue local pay bargaining and how local trusts run their services to the best of their ability?

--- Later in debate ---

[Chris Skidmore]

The debate is not so much about regional pay because, as my hon. Friend says, there are local considerations to be taken into account; it is about what is the right pay. The right pay is not about lowering pay in poor areas, but about having the right pay in all areas. The right pay is the market rate for an individual, a professional with an individual mix of skills, expertise and experience. One of the problems with the national pay structure is that if trusts want to pay someone more, perhaps an expert, they will be prevented from doing so, which I think is wrong.

[John Pugh (Southport) (LD)]

The hon. Gentleman objected to the use of the word “cartel”. In what sense is it inappropriate in this context?

[Chris Skidmore]

I believe that “cartel” is a rather offensive word to use in this context, because it has connotations that are inappropriate for health care professionals who are doing their best to ensure that the NHS survives in the long term. That is the crux of the debate. Let us look at staffing costs. The Labour Government made a significant investment in the NHS over 13 years. It would be churlish to deny that, but it would also be churlish to deny the fact that a huge proportion of those costs were soaked up in pay.

[Jack Dromey]

The hon. Gentleman has just spoken about paying people the market rate. Sadly, there is a low-wage economy in much of the south-west. That is precisely why regional pay was rejected in the lead-up to “Agenda for Change”. It would lead to the market rate being applied in much of the south-west, driving down pay and conditions of employment. Does he, as a south-west Member of Parliament, support regional pay bargaining for the south-west?

[Chris Skidmore]

What I support is south-west trusts coming together as health care professionals and working out what is best for them in order to survive financially for the future.

I want to read from Chris Brown’s reply to my letter:

“The Consortium was established in response to the serious financial and operational challenges facing the NHS, both now and in the future, and will work to identify ways in which taxpayer funding may be more efficiently used in order to protect both employment and the continued delivery of high quality healthcare.”

There is a significant point in that. I do not want redundancies in the NHS, but if we do not come up with a workable solution for the future, that is what Opposition Members will see, and it will be on their watch if they believe that we should follow the national pay structure. I do not want to see redundancies, and neither do the trusts, which is why they have come together constructively, and they should not be scolded for doing so.

Mr Brown’s letter continued:

“More than two thirds of NHS expenditure is on staffing costs. In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor, the independent regulator for NHS Foundation Trusts, has also estimated that NHS organisations with a turnover or around £200m will need to produce savings of around £9m a year for each year until at least 2016/17 to remain in financial health.”

That is why the consortium has been formed. We cannot forget the financial challenge.

[Andy Burnham]

The hon. Gentleman said that the Labour Government gave too much to nurses and midwives in pay—[Interruption.] He said that we spent too much on pay. He also said that the market rate of pay should apply in his area. I want to ask him a direct question. Does he think that his constituents who work in the NHS are overpaid?

[Chris Skidmore]

No, I think that the right hon. Gentleman is misrepresenting what I said. The fact is that we have got to the point—[Interruption.] Nurses, doctors and health care professionals should be paid according to their skills. They should be paid according to what the trusts can afford. The problem we have is that, with an ageing population—

[Andy Burnham]

So they should be paid less?

[Chris Skidmore]

No, they should not be paid less. The right hon. Gentleman should stop splitting hairs. If we want a health care service that is viable for the future, where will the money come from? Perhaps he can answer that. What would he do to be able pay for the future of the NHS, given the demographic challenge we face?

[Andy Burnham]

If the hon. Gentleman gets rid of national pay in the south-west, does he think that the trusts in the consortium, or cartel, should receive a national tariff that factors in a national rate of pay, or should they be paid less for the work they do?

[Chris Skidmore]

What I find so frustrating about this debate is that the right hon. Gentleman has thrown his principles out of the window. He once defended flexibility for foundation trusts, but he now no longer trusts professionals in the way he really should.

[Mr Dorrell]

My hon. Friend asked the shadow spokesman a question as though it was academic, but actually it is not academic. When the right hon. Gentleman was responsible for these things, we know what he thought because it is there on the record. The policy was

“to increase regional and local flexibility in public service pay systems.”

That is what he thought was necessary when he had responsibility.

[Chris Skidmore]

I thank my right hon. Friend for his intervention, which is much appreciated.

The key point is that staffing costs will have to be managed for the future. We cannot get away from that fact. If I am honest in making that point, I am sorry, but we all, regardless of political parties, have to understand the financial pressures the NHS will come under in the decades to come. Staffing costs make up between 70% and 75% of NHS spend. The Nicholson challenge is absolutely vital, and it is not just over four years, as the right hon. Member for Leigh well knows; it will be for ever. We will have to commit to making those efficiency savings so that they can be reinvested in the service if we are to keep the NHS free at the point of delivery. I want an NHS that is free at the point of delivery for my children, yet to be born, and I want it to be there at the end of the century. In order to do that, we need to be responsible about where savings will be made. We are pushing savings at the moment on the outside staffing costs of 20%. The pay freeze has managed to save around £2.5 billion for the Nicholson challenge, as we have heard Mike Farrar from the NHS Confederation explain.

There is a problem, in that the NHS pay freeze will come to an end next year and will have to be renegotiated. Rather than cutting staff numbers, the NHS Confederation is pushing for us to be responsible about what is put into the NHS. That is what we have to consider. We cannot get away from this challenge. It is irresponsible to fly in the face of reorganisation. We need to make savings so that they can be reinvested for the future. That is why it is responsible for the trust and the south-west consortium to take the issue seriously, and it will be up to the individual trusts to decide at the end of the year.

I cannot see any reason why local trusts and health care professionals, who know what is best for their local areas, should not be able to take advantage of the regulations for local flexibilities set out in “Agenda for Change” to ensure that the NHS has the best possible productivity. Let us not forget that the NHS is not free; it is paid for by taxpayers, who deserve the best possible value for money. If the south-west consortium can deliver that, it should be applauded.

--- Later in debate ---

[Alison Seabeck]

The hon. Lady speaks from a wealth of experience of working in the NHS. She is absolutely right on that point, which I will make more of later in my speech.

The public have a right to know what the Government’s position is, but as with so much else, confusion reigns. The Deputy Prime Minister has said at times that he is not in favour of regional pay, but it will be interesting to see how he votes today. The Chancellor of the Exchequer is clearly in favour, but the Prime Minister says nothing. The Secretary of State for Health has not helped to clarify matters today. The amendment, which is in the name of the Chief Secretary to the Treasury, is interesting. It states that the Government will not go down the route of regional pay

“unless there is strong evidence and a rational case for proceeding”.

How will the Government consult and gather the evidence to decide whether there is a rational case for regional pay? When will the Minister make the evidence available to Members of the House?

The Government must understand that the proposal is causing huge concern. The debate is not just about public sector pay restraint. Labour Members have accepted that there needs to be restraint in the public sector. We are not saying that that should not happen in times of austerity, but there is a need for equal pay for equal work. It is wrong if a nurse in Plymouth, working the same hours, doing the same job and providing the same high-quality care, is paid less than her counterpart in a hospital in Peterborough or Preston.

[Chris Skidmore]

Does the hon. Lady therefore disagree with the concept of London weighting, which has been around since the 1920s? There are 44 London MPs in the London area, so I would be interested in her views on London weighting.

Winterbourne View

Chris Skidmore Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I shall certainly consider the hon. Lady’s point and am happy to discuss it further with her. At the end of the day, we must ensure that people in highly vulnerable situations are adequately protected. I want to ensure that all the steps we take are aimed at that goal.

[Chris Skidmore (Kingswood) (Con)]

The Minister has mentioned raising the standard and quality of care providers. Will he consider the introduction of a starred grading system for care providers, so that we have absolute transparency on how well they are performing, and so that we know the most excellent care providers and the worst?

[Norman Lamb]

My hon. Friend raises an important point. One thing we are doing on the NHS Choices website is having quality indicators for every care home, nursing home and so on. That means that any individual looking for a care home for a loved one will be able to find out much more about the quality of the care that an organisation provides. In due course, the website will include user reviews, so that people who have experienced care in those homes will have their voices heard. That openness of information could have a transformational effect in driving up standards.

NHS Annual Report and Care Objectives

Chris Skidmore Excerpts

Wednesday 4th July 2012 Commons Chamber

[Mr Lansley]

I am grateful to the hon. Gentleman. I said during the passage of the Health and Social Care Act 2012 that it had been intensively considered in its every aspect. The Act expressly rules out the introduction of any charges across the NHS, other than by further primary legislation, and there is no primary legislation to permit such a thing. So I reiterate the point: there will be no additional charging for treatment in the NHS.

[Chris Skidmore (Kingswood) (Con)]

Many of my constituents are concerned that under the Labour Government £11 billion of PFI contracts were signed, which will cost the NHS over £60 billion to pay back. They are concerned that PFI, Labour’s toxic legacy to the NHS, has the potential to bankrupt many health trusts. Can my right hon. Friend reassure my constituents about possibly renegotiating some of these contracts?

[Mr Lansley]

My hon. Friend makes an important point. When the shadow Secretary of State was attempting to suggest that there were trusts in trouble across the country, he might have had the humility to admit that the hospital trusts in the greatest difficulty are the ones that were saddled with unsustainable debt by the Labour Government’s poorly negotiated PFI projects. He might have instanced Peterborough and Stamford Hospitals NHS Foundation Trust. Monitor wrote to him and his colleagues, telling them that that PFI project should not have proceeded. The Labour Government went ahead with it anyway and it is now unsustainable.

We have been very clear. We have gone through a process of identifying where trusts can manage, not least with us assisting them. In the latter part of last year we identified seven trusts that we will step in and support if we believe that they are otherwise unable to restore their finances to good health. It will entail about £1.5 billion of total support for them to be able to pay for their PFI projects. Where there are opportunities for renegotiation we will exercise them, but unfortunately it is in the nature of coming into government that we inherit what the previous Government left us. We were left with 102 hospital—[Interruption.] The shadow Secretary of State says from a sedentary position that they were our PFI schemes. No NHS PFI scheme was signed before the Labour Government took office in 1997. Two years ago we inherited 102 hospital projects with £73 billion of debt, yet the Opposition thought that in the years before they had used taxpayers’ money to build these new hospitals. No, they did not. They saddled the NHS for 30 years with that debt.

NHS (Foreign Nationals)

Chris Skidmore Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Chris Skidmore (Kingswood) (Con)]

Thank you, Mr Streeter, for calling me to speak. It is an honour to serve under your chairmanship.

I very much appreciate having the opportunity to speak on the issue of foreign nationals’ use of the NHS today. I know that it is of concern to all Members of the House, regardless of political party, because for many of us it is a huge issue for our constituents, who are genuinely concerned about the NHS, which is free at the point of use.

Obviously, the constituents I speak to accept that we should never turn away at the door anybody who is in genuine need, whether they are asylum seekers or not. Obviously, there are big public health issues and I welcome the fact that the Government have extended HIV treatment to those people in need regardless of nationality, because that will benefit the whole of our society. However, we cannot get away from the fact that there is a large issue, and one that is growing, regarding the use of NHS facilities by foreign nationals who are ineligible for free care.

As a member of the Health Committee, I am particularly concerned about this issue and I have put down several parliamentary questions, dating back to last year. The Government responded that roughly £35 million had been written off by hospital trusts, in terms of debts that had been accrued by foreign nationals and that had neither been paid back nor claimed back. The trusts involved did not include foundation trusts, so I made a freedom of information request of all trusts across the country. The data that I received back from the 118 NHS trusts that replied to me showed that just over £40 million of debt accrued by foreign nationals had been written off.

Those data also showed that there is a huge variation in relation to the collection of debt accrued by foreign nationals. The highest figure for such debt was for Guy’s and St Thomas’ NHS Foundation Trust, which had written off almost £6 million of such debt since 2004. My own local trust, North Bristol NHS Trust, had written off £1.7 million of such debt. The data showed that some trusts were acting contrary to the regulations and the current guidance, which

“place a legal obligation on the trust providing treatment to identify those patients who are not ordinarily resident in the United Kingdom; establish if they are exempt from charges by virtue of the Charging Regulations; and, if they are not exempt, make and recover a charge from them to cover the full cost of their treatment.”

That is what trusts should be doing when foreign nationals who are ineligible for free care come through their doors. However, it was clear from the information that I received in response to my FOI request that many trusts were not even collecting those data, which is contrary to the guidance. Of those trusts that were collecting the data, some had gone back to 2000 to collect them and some had gone back to 2004. There was a large variation in the data that cannot simply be explained by the fact that some trusts were more willing than others to claim back the debt that they were owed from foreign nationals.

There is anecdotal evidence, too. I have heard from some Members who wanted to be in Westminster Hall today for this debate but were unable to make it, and they asked me to raise some issues. In particular, one MP had a constituent who had come to them regarding an American visitor who was staying with them. During their holiday, the American visitor became ill and attended NHS facilities for treatment. They then contacted their medical insurer in the US, which suggested that they provide proof of the cost of their treatment; the American visitor would need a receipt from the NHS, so that they could claim back the money from their medical insurer. However, when they contacted the trust in question, they were told that no such receipt was available and the trust itself had not collected the data about the nature and cost of their treatment, even though this visitor was a foreign national and ineligible for free NHS care, and actually wanted to pay the bill because they were very grateful for the fantastic treatment that they had received. Consequently, a receipt could not be provided.

So there are examples of how trusts are clearly not following the guidance and collecting NHS debt from foreign nationals. It is particularly worrying that a 2008 survey of NHS managers suggested that a third of them did not even bother to ask patients whether they were eligible for free treatment when they arrived at hospital.

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

Is the hon. Gentleman now talking about those foreign nationals who arrive here specifically to receive treatment, or those foreign nationals who come here as visitors, become ill and are then unable—for whatever reason—to pay for their treatment? We must not mix the foreign nationals with political asylum seekers, overstayers and others who, for whatever reason, live here for many years but are not eligible to receive NHS treatment. Is the hon. Gentleman mixing those two groups, or separating them?

[Chris Skidmore]

No, I am certainly not mixing them and I will come to the issue of eligibility that is defined around the term “ordinarily resident”. I want to talk about that in terms of the historic issues that determine whether foreign nationals should be charged for treatment. Obviously, there have been various reports in the past decade, including a 2007 report by the Joint Committee on Human Rights that examined services available to asylum seekers, and those reports have raised that very issue. If access to care and treatment was denied to those who are vulnerable and in genuine need of care, that would undeniably make the situation worse and cause them far greater distress and harm. In those circumstances, we have a right and a moral duty to ensure that people are treated.

On the other hand, we have what some red-top newspapers might call “health tourism”. I use that phrase with some trepidation, because the situation is certainly more complicated than that phrase implies; it suggests that people are simply flooding in across our borders to ensure that they can receive NHS treatment, and that is certainly not the case. There are eligibility criteria that apply, but my concern is that they are not being applied strictly enough by various trusts. On the back of the previous Government’s consultation on this issue, between February and June 2010, the current Government have now decided to tighten certain eligibility criteria, particularly regarding asylum seekers and specifically when asylum seekers have their right of asylum refused.

There is obviously an issue with border security as well, and I welcome the fact that the Government have introduced measures, through the Home Office, in relation to those who have left the country with unpaid debts to the NHS of more than £1,000. I put down a written question that suggested that each year there are 3,600 foreign nationals who accrue such a debt for their NHS treatment and that they should not be allowed re-entry to this country unless those debts were paid off. There is a spectrum through which one has to view who is a foreign national and who is “ordinarily resident”.

I do not deny that establishing the difference between those two groups can be very difficult and that there is a very fine balance to strike. Nevertheless, it is clear from the data that I have received in response to my FOI request that the current system is not working. If there is a situation, as there is at the moment, whereby debts are being accrued and not reclaimed, and whereby a third of NHS managers are not even asking patients whether they are eligible for free treatment or whether they are a foreign national, that is a very big issue.

In many ways, one can understand why someone working within an NHS trust would not want to ask someone about their nationality; it might simply be easier to provide treatment. That is because of the simple fact that, once someone has been categorised as a foreign national and therefore they must be charged because they are ineligible for free care, those charges must be recouped. The costs of recouping those charges could far outweigh the charges themselves.

Moreover, I do not deny that some patients will turn up at an accident and emergency department or trust with a particular complication, which becomes severely worse. For whatever reason, they happen to die and there is no way in which the charges for which they would have been liable can be recouped. All those particular situations need to be taken into account.

In the Health Committee, we looked at how different trusts operate and collect their debts, or even monitor which people coming through their doors are eligible for free care and treatment. West Middlesex University hospital has what is called a “stabilised discharge system”. If a foreign national is admitted to hospital, the doctor first establishes whether there is a need for urgent life-saving treatment, which is obviously a priority for the NHS. If that is not the case, the person is told what treatment is required and how much it costs. If they are unwilling to pay, they are asked to leave. That policy in the hospital nearest Heathrow airport has saved the hospital £700,000 in each separate year. Even within the existing guidance and criteria, there are the means and possibilities by which trusts can ensure that the criteria are followed correctly and that savings can be made. I am sure that if every trust acted in the same way as the West Middlesex University hospital, we would see the amount of debts incurred by foreign nationals drop significantly.

The hon. Member for Ealing, Southall (Mr Sharma) mentioned the criteria around a foreign national and who is and is not eligible for care. The context of this debate, as I mentioned, is an historic one. It was not until 1989 that the British Government began to require certain overseas visitors to pay for hospital treatment. That was defined in regulations in 1977, when legislation permitting persons not ordinarily resident in the United Kingdom to be charged for NHS services began to be looked at.

How we define someone who is not ordinarily resident, as opposed to someone who is ordinarily resident, is interesting. In a way, it is a common law concept, but in NHS health care legislation there is no definition of “ordinarily resident”. The only definition comes from a 1982 judgment in the House of Lords, which was actually in the context of the Education Bill that was passing through the other place at the time. The definition of “ordinarily resident” was:

“living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being, whether they have an identifiable purpose for their residence here and whether that purpose has a sufficient degree of continuity to be properly described as ‘settled’ ”.

That means that UK citizenship and past or present payments of UK taxes or national insurance contributions, contrary to what many of our constituents might think, are not directly taken into account in the way that “ordinarily resident” has been defined.

In the review that they are currently conducting, I urge the Government to consider how we will define “ordinarily resident” in future. The NHS is a contributory system that people pay into to receive free care at the point of treatment. That is right. The NHS is free for citizens who have paid into the system. It cannot be a free-for-all for everybody to use. Our constituents wish us, as legislators, to address that concern.

It is clear that the current rules and regulations, having been addressed and re-addressed over time, have caused some confusion. In 2007, the Joint Committee on Human Rights produced a report on services to asylum seekers. It suggested that the new rules introduced in 2004 regarding asylum seekers and whether they were eligible for free care—or, once their asylum application had been turned down, whether they were still eligible for free care—caused confusion about entitlement. It suggested that the interpretation of the rules appeared to be inconsistent, and that in some cases people who were entitled to free treatment had been charged in error.

At the time, the Labour Government began a consultation looking at the use of primary care by foreign nationals using the NHS. It is clear that in acute and secondary care, charging regulations apply. The problem is that the implementation of those charging regulations has not been effective, and we need to be more stringent about the implementation of current guidance.

Currently, there are no charges for primary care, whether people are eligible or not. People can register with a GP for primary care, regardless of status. The Labour Minister at the time, in 2004, held a consultation on whether there should be charges for foreign nationals and people who were ineligible for free care. He suggested that the consultation was necessary because

“the rules about entitlement to primary care are best described as a muddle.”

I agree. In my own experience as MP for Kingswood, I have found a firm of lawyers in Bristol—Deighton Pierce Glynn—that has been writing to doctors urging them to register patients and saying that if they do not, it will take legal action, regardless of the patients’ nationality and eligibility for free care. I raised the matter in the local media, in the Bristol Evening Post. It is wrong, and I am concerned that our NHS will become a legal paradise for lawyers piggy-backing on doctors who are doing the best that they can with the resources that they have. They know that NHS resources are stretched and need to be rationed and that there is a big problem.

One lawyer responded in the Bristol Evening Post by saying that lawyers were not trying to change the law:

“We are trying to apply the law as it is. Nobody is excluded from GP treatment. It is very clear. Hospital treatment is different. People come to us when they have been refused registration with a GP. There is nothing in the law that permits them to do that. Refusing them isn’t lawful.”

This particular case concerned asylum seekers who had had their asylum applications refused. When the GP in question received the letter from Deighton Pierce Glynn, an unnamed member of staff said:

“Someone at the PCT read the letter and panicked. Do we just register everyone who is illegal?”

There is clearly confusion being stoked by certain members of the legal profession who seem to be taking advantage of the uncertainty of eligibility within primary care so that they can profit when their clients wish to apply to the NHS.

On the situation in primary care, I was interested in a question asked by the right hon. Member for Birkenhead (Mr Field) on 23 April 2012. He asked the Secretary of State for Health

“(1) what documentation a foreign national who seeks to register with a GP is required to provide;

(2) whether a foreign national on a six month visitor's visa is entitled to register with a GP;

(3) on what grounds a GP whose list has not been closed may refuse an application to register from a foreign national.”

The reply was:

“Under the terms of their existing contract, general practitioners (GPs) have discretion in accepting applications to join their lists. However, they cannot turn down an applicant on discriminatory grounds. They can only turn down an application if the primary care trust has agreed that they can close their list to new patients or if they have other reasonable non-discriminatory grounds.

There is no formal requirement to provide documentation when registering with a GP. However, many GPs, when considering applications, request proof of identity and confirmation of address, but in doing so they must not act in a discriminatory way.

A decision on whether to register a foreign national who has a six-month visitor visa is therefore currently for the GP to consider.”—[Official Report, 23 April 2012; Vol. 543, c. 701-02W.]

That raises issues. I do not like to quote Sir Andrew Green, the chairman of Migration Watch UK, but he stated:

“What this means is that someone getting off a plane with a valid visitor’s visa is, in effect, able to access the GP services of the NHS without ever having paid a penny into the system. Over one and a half million such visas were issued last year.”

Once someone is registered with a GP, the regulation and guidance mean that if they need further secondary care, it is the relevant NHS body’s duty and not the GP’s to establish the requirement for free hospital treatment. That raises the issue of the extent to which that takes place. Once someone is on the GP’s books, that is almost a rubber stamp into receiving secondary care.

I am not suggesting that GPs act as pseudo-immigration officials checking people’s eligibility for free care, but there clearly needs to be a more joined-up approach between the people who end up on GPs’ books and who are then referred by GPs to secondary care specialists, and what that then involves in terms of charging. When it comes to the issue of primary care and foreign nationals, I do not believe that foreign nationals should be entitled to free primary care. We should extend the charging regulations further.

[Mr Virendra Sharma]

I apologise; I should have congratulated the hon. Gentleman earlier on securing this debate, which is important not only to his constituents but to people all over the country, who take the issue seriously. It is also important in my constituency, where it is discussed every day.

I am a bit confused; I hope that the hon. Gentleman will clarify. He is mixing foreign nationals and those who have been here for many years. As I see it, in this debate, foreign nationals are those who come especially to register themselves for a few days, who receive treatment and who disappear without paying, due to system failures, although I will not get into that debate. For those already here, if GPs act as immigration officers or work on behalf of the UK Border Agency, that will mean health problems.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Chris Skidmore]

I certainly do not mean to confuse or mislead. When I say foreign nationals, I mean those who come to this country requiring care who are not defined as ordinarily resident under the current regulations. Personally, I think that we should consider the definition of “ordinarily resident”. I have no problem with people’s nationality, whether they are British or a citizen of whatever country. If they work in this country and are contributing to society, it is right that they should receive the free care towards which they have contributed.

Equally, exemptions apply for matters of public health and vulnerable groups. As the hon. Gentleman mentioned, if denying access to treatment could worsen the health of the community, let alone the individual, it is right that we should act responsibly. However, that should not preclude the creation of a clear definition of who is and is not eligible for care. One reason why we are having this exchange is that there is no clear, black and white definition. There will, obviously, be shades of grey, as there always are in health care. Health care professionals have a moral obligation to treat people in need, the sick and the vulnerable. I do not deny that, but we also have a moral obligation to our taxpayers to ensure that NHS money is spent as well as it can be.

A few people have come to me and said, “Mr Skidmore, it’s only £60 million out of a budget of £110 billion. Surely you’ve got to factor in debt. We should be able to expect that amount of debt to be written off.” I do not accept that argument. My local community hospital, Cossham hospital, is undergoing a £20 million refurbishment at the moment, and my constituents are so excited that it is taking place. That £60 million is a lot of money; it could have paid for the refurbishment of Cossham hospital three times over. We must count millions in order to save billions. During this efficiency drive, when we are trying to reinvest 15% to 20% of NHS resources in front-line care, it is a key aspect of the Nicholson challenge that we look for waste in the system and for instances where regulations are not being applied effectively.

I agree with the hon. Gentleman that we must be careful about how we define a foreign national. I do not want this to be seen as a xenophobic campaign, because it certainly is not. It is based on the conviction that the NHS is a national health service that provides free care at the point of use, but should not be abused; it should be free at the point of use, but not at the point of abuse.

The GP situation includes the lawyers at Deighton Pierce Glynn, who have been contacting GPs, and the Minister of State’s answer to the right hon. Member for Birkenhead about the issue of visas and documentation, which raises an issue that I think GPs would welcome.

Part of the consultation involves clarity about what GPs must look for when patients register in their practices, and whether they can say, “I’m afraid I cannot register you, because you don’t have the necessary data documentation.” As far as I understand it, the lawyers have been writing to GPs saying that by not registering patients, they are applying a discriminatory process. However, I was interested to read that paragraph 5.16 of the guidance on charging, in the section on GPs in primary care, says:

“It is important to see that all patients are treated the same way, to avoid allegations of discrimination.”

That is also clear in the Minister’s answer. The guidance goes on to say:

“It is not racist to ask someone if they have lived lawfully in the UK for the last 12 months as long as you can show that all patients—regardless of their address, appearance or accent—are asked the same question when beginning a course of treatment. The answer to that question may result in others needing to be asked, but again you will not be breaking any laws as long as those questions are asked solely in order to apply the Charging Regulations consistently.”

It is in the guidance that GPs have the right to ask, as long as they ask everybody. They will not be applying a discriminatory process.

As I said, in 2004—they reported in 2009—the previous Government began to consider whether we should extend charging to primary care and how eligibility criteria should be tightened. The review suggested that charging would not be extended to primary care. I hope that we as a Government might be able to reconsider. I know that this Government are committed to ensuring that national health care resources are spent in the right way. My constituents appreciate that, as I have said.

The Home Office has introduced measures so that anyone owing the NHS £1,000 or more will not be allowed to enter or stay in the UK unless the debt is paid. When that is implemented, the Home Office hopes to capture 94% of outstanding charges owed to the NHS; hopefully, it will have a significant impact. Encouragingly, the review commissioned on 18 March 2011 suggested:

“The existing system is still too complex, generous and inconsistently applied. While the NHS remains committed to providing immediate or necessary care, it is important that a balance of fairness and affordability is also struck.”

I agree entirely.

The review taking place will now consider

“qualifying residency criteria for free treatment; the full range of other current criteria that exempt particular services or visitors from charges for their treatment; whether visitors should be charged for GP services and other NHS services outside of hospitals”,

as I suggested; and

“establishing more effective and efficient processes across the NHS to screen for eligibility and to make and recover charges”.

I suggest that as part of the consultation, they consider West Middlesex University hospital and the good work being done there. Finally, the review will consider

“whether to introduce a requirement for health insurance tied to visas.”

I was encouraged when the Minister said:

“The NHS has a duty to anyone whose life or long-term health is at immediate risk, but we cannot afford to become an international health service, providing free treatment for all. These changes will begin the process of developing a clearer, robust and fairer system of access to free NHS services which our review of the charging system will complete. I want to see a system which maintains the confidence of the public while preventing inappropriate free access and continuing our commitment to human rights and protecting vulnerable groups.”

I agree with all those words.

I initiated this debate to ensure that Members have an opportunity to put their views as part of the consultation, which, hopefully, will report later this year. To reiterate, the NHS is a national health service, not an international one. Although we all believe that health care treatment must be free at the point of use, it cannot be free at the point of abuse. I urge the Minister to consider carefully what I have said and what other Members will say in this debate. We care passionately about the NHS. We want the NHS to continue as it has for six decades now. This issue is one that I know all our constituents and everyone in the House, regardless of party politics, will wish to ensure is solved.

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to contribute to a debate under your chairmanship for the first time, Mr Streeter. I congratulate the hon. Member for Kingswood (Chris Skidmore) on securing the debate. The use of the NHS by foreign nationals is a growing problem and it is important to take a moment to reflect on why we are discussing the issue today. It is a concern among hon. Members from all parties and, as my hon. Friend the Member for Ealing, Southall (Mr Sharma) said, among people representing all communities throughout the country. The issue is of paramount importance to a number of people.

As the previous Labour Government delivered the lowest ever waiting times and the highest ever level of patient satisfaction, along with 44,000 more doctors and 89,000 more nurses, the NHS became the envy of many other countries. The recent Commonwealth Fund comparative study of the state of the NHS makes that absolutely clear. However, a consequence of having one of the—if not the—best health services in the world was, and is, that it became increasingly attractive to foreign visitors. That has brought a number of issues that need to be addressed.

The commonly agreed figure that the hon. Member for Kingswood has mentioned is that the debt accrued by foreign nationals to the NHS is around £40 million. He is right to point that out. It is a lot of money—whether it is £40 million or £60 million—that would buy a lot of medicine and fund a lot of projects in a lot of communities. If the figure is £40 million, it is approximately 0.1% of the £3.5 billion that the Government are wasting on NHS reorganisation now. None the less, that figure is an awful lot of money.

The NHS is built on the principle that it should provide a comprehensive service based on clinical need, not ability to pay. However, at the same time, it is a national health service—not, as has been repeated on a number of occasions, an international health service. There must not and cannot ever be any doubt about that. Therefore, it is right that we impose charges for overseas visitors, who are defined in respect of NHS hospital treatment as people who are not ordinarily resident in the UK.

The previous Labour Government were committed to maintaining the existing system of charges, but they proposed a series of further safeguards, including amending the immigration rules so that anyone who accrued substantial medical debts would not be allowed back into the country if they left without settling their bill. I am genuinely pleased that the current Government have adopted so many of those recommendations. However, we need to look again at the ability to make and recover charges, and we would be happy to work with the Government on that issue. For example, the previous Government considered whether foreign nationals should be charged for NHS services outside the hospital. That issue warrants further close discussion.

We also need to learn from those hospitals that are more successful at recovering charges. The hon. Member for Kingswood referred to some of those. Hospitals have a legal duty to recover any charges made to overseas patients and, frankly, some hospitals need to be much better at that. Sometimes dealing with that problem can be as simple as improving the recording of contact details, so that the patient can be pursued for payment, but I accept that the rules and procedures could be demonstrably improved. The Government should ensure that that is done and, again, we will support them in their efforts to do so.

A relevant issue that has not been touched on today is the Olympics. It would be helpful if the Minister explained what plans are in place to ensure that the NHS can meet the rise in demand from overseas visitors during the games. Will she tell hon. Members what exemptions are in place for athletes and officials? “Newsnight” recently reported that Olympic VIPs could receive fast-track emergency care. With A and E waits already increasing, is there not a danger that taxpayers who are paying for the NHS and the Olympics will be pushed to the back of the queue?

[Chris Skidmore]

I would have raised the Olympics in my speech had it not been for the fact that I wanted this to be a cross-party debate. The criterion that Olympic officials and athletes should receive free treatment was part of the bid that was successful in 2005 under the previous Government. We would not have been awarded the Olympics if that had not been part of the 2005 bid.

[Mr Reed]

The hon. Gentleman makes a good point. He is obviously aware of the fact that although he, I and other hon. Members are privy to those details, the general public are not. There is a salient concern out there about the perceived emergence of a better standard of care being afforded to people who are involved in the Olympics. I visited Homerton hospital in Hackney, which is one—if not the—Olympic hospital in London. I saw some tremendously innovative professionals there who are developing innovative medical treatments and systems of working. They need to get the message across that local people who use that hospital on a daily basis will not be disadvantaged by the Olympics. We need a clear exposition of why that will not be the case.

Although I have considerable sympathy with the contributions I have heard this morning, all hon. Members must recognise that, under the UN convention on human rights, the UK has an international obligation to provide free NHS treatment to those seeking asylum here. All of the contributions I have heard today indicate that that will not be too hard to achieve, but hon. Members must guard against those Members who advocate that we should not fulfil that obligation, because the temptation will be too much for some. When we produce facts and figures used in support of the arguments, that must be acknowledged.

We must also guard against Members from all parties who advocate that the NHS should turn away pregnant mothers or patients in need of emergency care. Overall, this issue requires a diligent, careful approach. It is not the platform for a weird, xenophobic virility contest. I look forward to hearing what the Minister has to say. There may be little common ground between my party and the Government on the NHS, but we can agree that NHS care must always be based on clinical need, not ability to pay. At the same time, first and foremost, the NHS must serve the people of the United Kingdom—those whose taxes fund the NHS, those who believe in it passionately as the guarantor of a better society and those who expect it to be there for them when they need it. I hope that we can agree on that principle as we continue to debate the issue constructively and develop the fair and appropriate policy responses that the issue deserves.